Neusa Sica da Rocha

Avaliação de qualidade de vida e importância dada a espiritualidade/religiosidade/ crenças pessoais (SRPB) em adultos com e sem problemas crônicos de saúde

CONTEXTO: Nao existem estudos avaliando a associacao entre religiosidade e qualidade de vida, comparando pessoas doentes e saudaveis, independentemente do tipo de doenca e da idade. OBJETIVO: Verificar a associacao entre: (1) presenca de uma doenca cronica e a importância dada a espiritualidade/religiosidade/ crencas pessoais (SRPB); (2) presenca de um problema cronico de saude e qualidade de vida (QV), ajustada para fatores como idade, nivel socioeconomico (NSE) e sintomas depressivos; (3) QV e a importância dada a SRPB, tambem ajustada para os mesmos fatores. DELINEAMENTO: estudo transversal. Sujeitos: n = 241, sendo 122 pacientes internados e ambulatoriais com alguma doenca cronica, provenientes de um hospital universitario, e 119 individuos saudaveis membros ativos de comunidades religiosas. Instrumentos: a) WHOQOL-100 (QV); b) BDI (sintomas depressivos); c) WHOQOL-SRPBi - escala de importância dada as facetas do modulo de SRPB do WHOQOL-100 (importância dada a SRPB). RESULTADOS: Pacientes mostraram piores escores que os saudaveis na maioria dos dominios do WHOQOL-100, com excecao do dominio do SRPB. Os pacientes (media = 97,2 ± 13,0) tiveram escores mais altos que os saudaveis (media = 92,9 ± 16,4) na avaliacao de importância dada a SRPB (P = 0,03). Usando um modelo de regressao multipla, a importância dada a SRPB aparece positivamente associada com os dominios geral, psicologico, relacionamento social, ambiente e SRPB do WHOQOL-100 (beta = 0,10; beta = 0,17; beta = 0,12; beta = 0,11; beta = 0,72, respectivamente; P < 0,05), quando ajustado para idade, NSE, sintomas depressivos e a presenca de um problema cronico de saude. CONCLUSAO: A importância da SRPB aparece positivamente associada com a QV na maioria de seus dominios, independentemente de outros fatores envolvidos. Esse achado pode ser considerado ao se planejarem intervencoes para a melhoria da QV de pacientes acometidos por problemas cronicos de saude.

An introduction to Rasch analysis for Psychiatric practice and research

This article aims to present the main characteristics of Rasch analysis in the context of patient reported outcomes in Psychiatry. We present an overview of the main features of the Rasch analysis, using as an example the latent variable of depressive symptoms, with illustrations using the Beck Depression Inventory. We will show that with fitting data to the Rasch model, we can confirm the structural validity of the scale, including key attributes such as invariance, local dependency and unidimensionality. We also illustrate how the approach can inform on the meaning of the numbers attributed to scales, the amount of the latent traits that such numbers represent, and the consequent adequacy of statistical operations used to analyse them. We would argue that fitting data to the Rasch model has become the measurement standard for patient reported outcomes in general and, as a consequence will facilitate a quality improvement of outcome instruments in psychiatry. Recent advances in measurement technologies built upon the calibration of items derived from Rasch analysis in the form of computerized adaptive tests (CAT) open up further opportunities for reducing the burden of testing, and/or expanding the range of information that can be collected during a single session.

Validação brasileira do Instrumento de Qualidade de Vida/espiritualidade, religião e crenças pessoais

OBJECTIVE To analyze the psychometric properties of the World Health Organizations Quality of Life Instrument--Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB). METHODS The WHOQOL-SRPB, the Brief Spiritual/Religious Coping Scale (Brief-SRCOPE Scale), the WHOQOL-BREF and the Beck Depression Inventory (BDI) were consecutively applied in a convenience sample of 404 patients and workers of a university hospital and workers of a university, in the city of Porto Alegre, Southern Brazil, between 2006 and 2009. The sample was stratified by sex, age, health status and religion/belief. The retest of the two first instruments was conducted with 54 participants. Exploratory factorial analyses of the WHOQOL-SRPB with the method of main components were performed, without limiting the number of factors, and requiring eight factors concomitantly with the WHOQOL-BREF items. RESULTS The Brazilian Portuguese version of the WHOQOL-SRPB (General SRPB-Domain) showed construct validity, with a discriminatory validity between believers and non-believers (t = 7.40; p = 0.0001); concurrent criterion-related validity, distinguishing depressed individuals from non-depressed ones (t = 5.03; p = 0.0001); convergent validity with the WHOQOL-BREF (physical r = 0.18; psychological r = 0.46; social r = 0.35; environmental r = 0.29; global r = 0.23; p = 0.0001) and with the SRPB-Domain of the WHOQOL-100 (r = 0.78; p = 0.0001); and convergent/discriminatory validity with the brief SRCOPE Scale (with positive SRCOPE r = 0.64; p = 0.0001/negative SRCOPE r = -0.03; p = 0.554). Excellent test-retest reliability (t = 0.74; p = 0.463) and internal consistency (α = 0.96; intrafactorial correlation 0.87 > r > 0.60; p = 0.0001) were observed. The exploratory factorial analyses performed corroborated the eight-factor structure of the WHOQOL-SRPB multicenter study. CONCLUSIONS The Brazilian Portuguese version of the WHOQOL-SRPB showed good psychometric qualities and use valid and reliable in Brazil. It is suggested that new studies be conducted with specific populations, such as different religions, cultural groups and/or diseases.OBJETIVO: Analisar propriedades psicometricas do Instrumento de Qualidade de Vida da Organizacao Mundial da Saude - Modulo Espiritualidade, Religiosidade e Crencas Pessoais (WHOQOL-SRPB). METODOS: O WHOQOL-SRPB, a Escala de Coping Religioso/Espiritual Abreviada (CRE-Breve), o WHOQOL-Breve e o BDI foram consecutivamente aplicados em amostra de conveniencia de 404 pacientes e funcionarios de hospital universitario e funcionarios de universidade, em Porto Alegre, RS, entre 2006 e 2009. A amostra foi estratificada por sexo, idade, estado de saude e religiao/crenca. O reteste dos dois primeiros instrumentos foi realizado com 54 participantes. Analises fatoriais exploratorias do WHOQOL-SRPB pelo metodo dos componentes principais foram realizadas sem delimitar o numero de fatores, solicitando oito fatores e em conjunto com os itens do WHOQOL-Breve. RESULTADOS: O WHOQOL-SRPB em portugues brasileiro (Dominio SRPB-Geral) apresentou validade de construto, com validade discriminativa entre crentes de nao-crentes (t = 7,40; p = 0,0001); validade relacionada ao criterio concorrente, discriminando deprimidos de nao-deprimidos (t = 5,03; p = 0,0001); validade convergente com o WHOQOL-Breve (com fisico r = 0,18; psicologico r = 0,46; social r = 0,35; ambiental r = 0,29; global r = 0,23; p = 0,0001) e com o Dominio SRPB do WHOQOL-100 (r = 0,78; p = 0,0001); e validade convergente/discriminante com a Escala CRE-Breve (com CREpositivo r = 0,64; p = 0,0001/CREnegativo r = -0,03; p = 0,554). Observou-se excelente fidedignidade teste-reteste (t = 0,74; p = 0,463) e consistencia interna (α = 0,96; correlacao intrafatorial 0,87 > r > 0,60, p = 0,0001). As analises fatoriais exploratorias realizadas corroboraram a estrutura de oito fatores do estudo multicentrico do WHOQOL-SRPB. CONCLUSOES: O WHOQOL-SRPB em portugues brasileiro apresentou boas qualidades psicometricas e uso valido e fidedigno para uso no Brasil. Sugerem-se novos estudos com populacoes especificas, como diferentes religioes, grupos culturais e/ou doencas.OBJETIVO: Analizar propiedades psicometricas del Instrumento de Calidad de Vida de la OMS - Modulo Espiritualidad, Religiosidad y Creencias Personales (WHOQOL-SRPB). METODOS: El WHOQOL-SRPB, la Escala de Coping Religioso/Espiritual Abreviada (CRE-Breve), el WHOQOL-Breve y el BDI fueron consecutivamente aplicados en muestra de conveniencia de 404 pacientes y funcionarios de hospital universitario y funcionarios de universidad, en Porto Alegre, Sur de Brasil, entre 2006 y 2009. La muestra fue estratificada por sexo, edad, estado de salud y religion/creencia. La reevaluacion de los dos primeros instrumentos fue realizada por 54 participantes. Analisis factoriales exploratorias del WHOQOL-SRPB por el metodo de los componentes principales fueron realizadas, sin delimitar el numero de factores, solicitando ocho factores y en conjunto con los itens del WHOQOL-Breve. RESULTADOS: El WHOQOL-SRPB en portugues-brasileno (Dominio SRPB-General) presento validez de constructo, con validez discriminativa entre creyentes de no creyentes (t=7,40; p=0,0001); validez relacionada con el criterio concurrente, discriminando deprimidos de no deprimidos (t=5,03; p=0,0001); validez convergente con el WHOQOL-Breve (con fisico r=0,18; psicologico r=0,46; social r=0,35; ambiental r=0,29; global r=0,23; p=0,0001) y con el Dominio-SRPB del WHOQOL-100 (r=0,78; p=0,0001); y validez convergente/discriminante con la Escala CRE-Breve (con CRE positivo r=0,64; p=0,0001/CRE negativo r=-0,03; p=0,554). Se observo excelente fidedignidad test-retest (t=0,74; p=0,463) y consistencia interna (α=0,96; correlacion intrafactorial 0,87>r>0,60, p=0,0001). Los analisis factoriales exploratorios realizados corroboran la estructura de ocho factores de estudio multicentrico del WHOQOL-SRPB. CONCLUSIONES: El WHOQOL-SRPB en portugues-brasileno presento buenas cualidades psicometricas, siendo valido y fidedigno para uso en Brasil. Se sugieren nuevos estudios con poblaciones especificas, como diferentes religiones, grupos culturales y/o enfermedades.

The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI)

BACKGROUND The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> or = 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.

Is there a measurement overlap between depressive symptoms and quality of life

BACKGROUND Previous studies found that depression is associated with a broad impairment in quality of life (QOL). This finding might be associated to a measurement overlap. METHODS The objective of this study was to verify whether the items of the World Health Organization Quality of Life Instrument-Abbreviated version (WHOQOL-BREF), a measure of generic QOL, are invariant among patients having a current major depressive episode who come from primary care services. We investigated data from primary care services from the 6 countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in the baseline sample of the Longitudinal Investigation of Depression Outcomes. The Rasch model was used to analyze items exhibiting differential item functioning (DIF) as a way of assessing invariance in relation to a depression factor defined by the diagnosis of depression using the Composite International Diagnostic Interview. In addition, the Center for Epidemiological Studies-Depression Scale (CES-D) score was correlated with the item and domain scores of the WHOQOL-BREF using the Pearson coefficient. RESULTS The sample consisted of 2359 subjects, of which 1193 had a confirmed diagnosis of a current major depressive episode. Of the 26 items of the WHOQOL-BREF, 11 showed DIF due to the depression factor, and the physical domain presented more items displaying DIF. All Pearson coefficients between the WHOQOL-BREF item and domain scores and the CES-D score were weak and moderate (r = -0.13 to r = 0.43). CONCLUSIONS Our findings indicate that most WHOQOL-BREF items do not exhibit DIF for a current major depressive episode and the variance associated with depression in this generic QOL measure is restricted to some facets of this construct. Thus, we recommend this restricted adjustment for depression in future analyses of this measure. Furthermore, our study indicates that researchers must measure QOL regardless of depression severity.

Cross-Cultural Evaluation of the WHOQOL-BREF Domains in Primary Care Depressed Patients Using Rasch Analysis

Background. The Rasch model prescribes procedures to ensure that a scale constructed from multiple items conforms to fundamental requirements of interval scales of measurement. Objective. To test the Rasch properties of the domains of the World Health Organization Quality of Life Instrument–abbreviated version (WHOQOL-BREF) in depressed patients from primary care settings. Design. Cross-sectional, cross-national study. Setting. Primary care. Patients. The sample consisted of 1193 patients having a confirmed diagnosis of depression from 6 countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in the Longitudinal Investigation of Depression Outcomes (LIDO) study. Measurements. The Composite International Diagnostic Interview (CIDI) diagnosed depression, whereas the Center for Epidemiological Studies Depression Scale (CES-D) assessed severity of depression. The WHOQOL-BREF measured generic quality of life (QOL). Results. Three of the 4 WHOQOL-BREF domains (physical, psychological, and environment) conform to the Rasch model expectations, following adjustments required mainly because of individual item misfit or differential item functioning (DIF) due to age or country. The social domain showed relatively poor psychometric properties, as observed in previous studies. Conclusions. The Rasch analysis demonstrated that, with some modifications, all domains of the WHOQOL-BREF, except for the social domain, provide an interval scale measure of generic subjective QOL in the context of depressed primary care patients in 6 countries worldwide.

Intrinsic religiosity, resilience, quality of life, and suicide risk in depressed inpatients

BACKGROUND Religiosity is inversely related to depression and is directly associated with positive psychological outcomes. Nonetheless, there is no consensus on whether or how religiosity could impact and protect against depression. The present study evaluated the association between intrinsic religiosity and resilient psychological characteristics in depressed inpatients. METHODS A sample of 143 depressed patients was prospectively evaluated in an inpatient psychiatric treatment in South Brazil. High Intrinsic Religiosity (HIR) and Low Intrinsic Religiosity (LIR) patients were compared across socio-demographic information, clinical measures, religiosity, resilience and quality of life. A linear regression model was used to evaluate the association between intrinsic religiosity and resilience, and the Cohen d test was utilized to assess effect sizes. RESULTS At admission, HIR patients showed higher HAM-D (p=0.05), BPRS (p=0.02), GAF (p=0.02), and CGI (p=0.03) scores, lower educational levels (p=0.04), higher social support (p=0.05), and fewer previous suicide attempts (p=0.05). At discharge, HIR patients showed higher quality of life (p=0.001) and higher resilience (p=0.000), with a large effect size difference between groups (1.02). Based on a linear regression model (adjusted r=0.19, p=0.000), intrinsic religiosity was associated with resilience, controlling for covariates. CONCLUSION In a sample of depressed inpatients, intrinsic religiosity was found to be associated with resilience, quality of life, and fewer previous suicide attempts. These findings support the relevance of religiosity assessments in mental health practice and support the hypothesis that resilient psychological characteristics may mediate the positive effects of intrinsic religiosity in depression.

Evaluation of quality of life in adults with chronic health conditions: the role of depressive symptoms

OBJECTIVE The negative impact of depressive symptoms on quality of life has been the focus of increasing attention, yet this relation remains unstudied in samples from developing countries. The objective of this study was to determine whether the occurrence of depressive symptoms is associated with impaired quality of life and whether this association remains significant after adjustment for some variables. METHOD A convenience sample was selected and the measures used were the WHOQOL-100, to assess quality of life, the Beck Depression Inventory, to screen for depressive symptoms, and the Economic Classification Criterion - Brazil, to evaluate socioeconomic status. RESULTS One hundred nineteen healthy adults (community) and 122 adult patients (tertiary hospital) from Brazil were assessed. Depressive symptoms were negatively correlated with all the domains of quality of life, even after statistical control for age, socioeconomic status, and presence of chronic health conditions. Socioeconomic status was positively correlated with the social relationships and environmental domains of quality of life. CONCLUSION Our findings indicate that depressive symptoms and socioeconomic status are important elements affecting the relationship between chronic health conditions and quality of life in Brazil.

Validity of the Brazilian version of WHOQOL-BREF in depressed patients using Rasch modelling

OBJECTIVE To assess the validity of the Brazilian version of the World Health Organization Quality of Life Instrument - Abbreviated version (WHOQOL-BREF) in adults with major depression, using Rasch modelling. METHODS Study analyzing data from the baseline sample of the Longitudinal Investigation of Depression Outcomes in Brazil, including a total of 208 patients with major depression recruited in a primary care service in Porto Alegre (Southern Brazil), in 1999. The Center for Epidemiological Studies Depression Scale was used to assess intensity of depression; the WHOQOL-BREF to assess generic quality of life; and the Composite International Diagnostic Interview version 2.1 for the diagnosis of depression. RESULTS In the Rasch analysis, the four domains of WHOQOL-BREF showed appropriate fit to this model. Some items needed adjustments: four items were rescored (pain, finances, services, and transport); two items (work and activity) were identified as having dependency of responses, and one item was deleted (sleep) due to multidimensionality. CONCLUSIONS The validation of the WHOQOL-BREF Brazilian version using Rasch analysis complements previous validation studies, evidencing the robustness of this instrument as a generic cross-cultural quality of life measure.OBJETIVO: Evaluar la validez de la version brasilera del Instrumento de Calidad de Vida de la Organizacion Mundial de la Salud, abreviado en ingles WHOQOL-BREF, en adultos con depression, usando el modelo de Rasch. METODOS: Se analizaron datos de la base de Investigacion Longitudinal de Resultados de Depresion en Brasil, incluyendo un total de 208 pacientes con derpesion mayor recluidos en servicio de ciudado primario en Porto Alegre (Sur de Brasil), en 1999. El Centro de Estudios Epidemiologicos de Depresion fue usado para evaluar la intensidad de la depresion; el WHOQOLBREF para evaluar la calidad generica de vida; y la Entrevista Internacional Compuesta para el Diagnostico version 2.1 para el diagnostico de la depresion. RESULTADOS: En el analisis Rasch, los cuatro dominios del WHOQOL-BREF mostraron ajuste apropiado con el modelo. Algunos items necesitaron ajustes: cuatro items fueron revalorados (dolor, financias, servicios y transporte), dos items (trabajo y actividad) fueron presentaron dependencia de respuestas, y uno de los items fue eliminado (dormir) debido a multidimensionalidad. CONCLUSIONES: La validacion del WHOQOL-BREF version brasilera usando analisis Rasch complementa estudios de validacion previa, evidenciando lo robusto de este instrumento como una medida generica transcultural de la calidad de vida.

Gender differences in perception of quality of life in adults with and without chronic health conditions: the role of depressive symptoms

Previous studies have shown that chronic conditions have a negative impact on quality of life. Furthermore, this impact appears to be different in males and females, but it is not yet clear what factors may mediate this relationship. Females with chronic health conditions had poorer quality of life in the physical and psychological domains as compared to males with chronic health conditions. The difference between male and female patients in the psychological domain disappeared when the analysis was adjusted for confounding factors such as age, presence of a chronic health condition, socioeconomic status, and depressive symptoms.